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Li C, He G, Mi Z, Huang D, Hu Y. Evaluation of ultrasound-guided PFO occlusion in the treatment of vestibular migraine. Technol Health Care 2024:THC231815. [PMID: 38820027 DOI: 10.3233/thc-231815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Currently, surgery is the mainstay of the clinical treatment of vestibular migraine. OBJECTIVE To investigate the clinical efficacy and safety of using transesophageal echocardiography-guided interventional closure of the patent foramen ovale (PFO) in the treatment of vestibular migraine. METHODS The study included 52 patients with vestibular migraine who were admitted to our hospital between June 2019 and June 2021. All selected patients underwent a transesophageal echocardiography-guided interventional closure of the PFO and were followed up for one year after surgery. We observed the clinical efficacy and surgical success rate one year after surgery and compared the improvement in clinical symptoms and perioperative safety at different time points. RESULTS The overall remission rate and the surgical success rate for the 52 patients with vestibular migraine one year after surgery were 86.54% and 96.15%, respectively. Compared to the pre-surgery levels, there was a significant progressively decreasing trend in the scores on the Headache Impact Test-6 (HIT-6), Visual Analogue Scale (VAS), Migraine Disability Assessment (MIDAS) questionnaire, frequency of headaches, and duration of headaches in patients with vestibular migraine at 1, 3, and 6 months after surgery (P< 0.05). Among the 52 patients, one developed atrial fibrillation three hours after surgery, which then spontaneously converted to sinus rhythm, and none of the other patients had adverse outcomes such as hematoma at the puncture site during the perioperative period. CONCLUSION Transesophageal echocardiography-guided interventional closure of the PFO for treating vestibular migraine significantly improved the symptoms of migraine in patients, with a high surgical success rate, significant clinical efficacy, and favorable safety.
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Affiliation(s)
- Chao Li
- Department of Cardiothoracic Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Gang He
- Department of Cardiothoracic Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zeyu Mi
- Department of Cardiothoracic Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Daxin Huang
- Department of Cardiothoracic Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yulin Hu
- Department of Nephrology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Butera G, Biondi-Zoccai GGL, Carminati M, Caputi L, Usai S, Bussone G, Meola G, Delogu AB, Sheiban I, Sangiorgi G. Systematic review and meta-analysis of currently available clinical evidence on migraine and patent foramen ovale percutaneous closure: much ado about nothing? Catheter Cardiovasc Interv 2010; 75:494-504. [PMID: 20088014 DOI: 10.1002/ccd.22232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the role of transcatheter closure of patent foramen ovale on the occurrence of migraine. BACKGROUND In recent years, a potential relationship between, migraine, stroke, and patent foramen ovale (PFO) has emerged. METHODS BioMedCentral, Google Scholar, and PubMed from January 2000 to December 2008 were systematically searched for pertinent clinical studies. Secondary sources were also used. Secondary prevention studies of transcatheter closure for patent foramen ovale were required to include at least more than 10 patients followed for more than 6 months. The primary end-point was the rate of cured or significantly improved migraine after percutaneous PFO closure. RESULTS After excluding 637 citations, we finally included a total of 11 studies for a total of 1,306 patients. Forty percent of the subjects included suffered from migraine, while most had a previous history of transient ischemic attack/stroke and were investigated retrospectively. Quantitative synthesis showed that complete cure of migraine in 46% (95% C.I.25-67%), while resolution or significant improvement of migraine occurred in 83% (95% C.I. 78-88%) of cases. CONCLUSIONS Notwithstanding the limitations inherent in the primary studies, this systematic review suggests that a significant group of subjects with migraine, in particular if treated after a neurological event, may benefit from percutaneous closure of their patent foramen ovale. However, many questions remain unsolved.
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Affiliation(s)
- Gianfranco Butera
- Department of Pediatric Cardiology and GUCH unit, Policlinico San Donato, IRCCS, San Donato Milanese, Italy.
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Nahas SJ, Young WB, Terry R, Kim A, Van Dell T, Guarino AJ, Silberstein SD. Right-to-left shunt is common in chronic migraine. Cephalalgia 2009; 30:535-42. [DOI: 10.1111/j.1468-2982.2009.02002.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura ( P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.
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Affiliation(s)
- SJ Nahas
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
| | - WB Young
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
| | - R Terry
- Jefferson Medical College, Philadelphia, PA, USA
| | - A Kim
- Jefferson Medical College, Philadelphia, PA, USA
| | - T Van Dell
- Jefferson Medical College, Philadelphia, PA, USA
| | - AJ Guarino
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - SD Silberstein
- Thomas Jefferson University Hospital, Department of Neurology, Philadelphia, PA, USA
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Dowson A, Mullen MJ, Peatfield R, Muir K, Khan AA, Wells C, Lipscombe SL, Rees T, De Giovanni JV, Morrison WL, Hildick-Smith D, Elrington G, Hillis WS, Malik IS, Rickards A. Migraine Intervention With STARFlex Technology (MIST) Trial. Circulation 2008; 117:1397-404. [PMID: 18316488 DOI: 10.1161/circulationaha.107.727271] [Citation(s) in RCA: 346] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Patent foramen ovale (PFO) is prevalent in patients with migraine with aura. Observational studies show that PFO closure resulted in migraine cessation or improvement in ≈80% of such patients. We investigated the effects of PFO closure for migraine in a randomized, double-blind, sham-controlled trial.
Methods and Results—
Patients who suffered from migraine with aura, experienced frequent migraine attacks, had previously failed ≥2 classes of prophylactic treatments, and had moderate or large right-to-left shunts consistent with the presence of a PFO were randomized to transcatheter PFO closure with the STARFlex implant or to a sham procedure. Patients were followed up for 6 months. The primary efficacy end point was cessation of migraine headache 91 to 180 days after the procedure. In total, 163 of 432 patients (38%) had right-to-left shunts consistent with a moderate or large PFO. One hundred forty-seven patients were randomized. No significant difference was observed in the primary end point of migraine headache cessation between implant and sham groups (3 of 74 versus 3 of 73, respectively;
P
=0.51). Secondary end points also were not achieved. On exploratory analysis, excluding 2 outliers, the implant group demonstrated a greater reduction in total migraine headache days (
P
=0.027). As expected, the implant arm experienced more procedural serious adverse events. All events were transient.
Conclusions—
This trial confirmed the high prevalence of right-to-left shunts in patients with migraine with aura. Although no significant effect was found for primary or secondary end points, the exploratory analysis supports further investigation. The robust design of this study has served as the model for larger trials that are currently underway in the United States and Europe.
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Affiliation(s)
- Andrew Dowson
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Michael J. Mullen
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Richard Peatfield
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Keith Muir
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Arif Anis Khan
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Christopher Wells
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Susan L. Lipscombe
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Trevor Rees
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Joseph V. De Giovanni
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - W. Lindsay Morrison
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - David Hildick-Smith
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Giles Elrington
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - W. Stewart Hillis
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Iqbal S. Malik
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
| | - Anthony Rickards
- From Kings College Hospital, London (A.D.); Royal Brompton Hospital, London (M.J.M., A.A.K, A.R); Princess Margaret Migraine Clinic Charing Cross Hospital, London (R.P.); Division of Clinical Neurosciences, University of Glasgow, Glasgow (K.M); Pain Research Institute, Liverpool (C.W.); Brighton and Sussex University Hospitals NHS Trust, Brighton (D.H.-S., S.L.L.); Hawthorn Surgery, Sutton Coldfield (T.R.); University Hospital, Birmingham (J.V.D.G.); Cardiothoracic Centre, Liverpool (W.L.M.); Barts
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